Study: Prolonged Rest No Better Than Usual Care for Adolescents With Concussions

Tuesday, January 06, 2015

Study: Prolonged Rest No Better Than Usual Care for Adolescents With Concussions

A new study published in the journal Pediatrics asserts that when it comes to treatment for concussion, rest is a good thing--but it may be possible for adolescents to get too much of it.

In a paper e-published ahead of print on January 5 (.pdf), researchers report on findings from a study of 88 patients, aged 11 to 22, who reported to a Wisconsin emergency department (ED) and were diagnosed as having experienced concussion. Of that number, 43 were prescribed "usual care" of 1–2 days of rest followed by a gradual return to activity, while the remaining 45 participants were prescribed strict rest for 5 days (no school, work, or physical activity).

Assessments were performed in the ED and at 3 and 10 days after injury. Participants also completed activity diaries that included a 19-symptom Post Concussive Symptoms Scale (PCSS).What researchers found was that while neurocognitive and balance tests showed no significant differences in the groups as they recovered, 50% of the participants assigned to strict rest took an average of 3 days longer to report symptom resolution. Additionally, the strict rest group reported higher PCSS scores than the usual-care group.

"Recommending strict rest from the ED did not improve symptom, neurocognitive, and balance outcomes in youth diagnosed with concussion," authors write. "Surprisingly, adolescents who were recommended strict rest after injury reported more symptoms over the course of this study."

Authors forwarded several possible explanations for the difference in symptom reporting, including the possibility that the more restrictive treatment influenced the patients' perceptions. "The deleterious effects of strict rest may have more to do with emotional distress caused by school and activity restriction," they write. "Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms."

The research was featured in stories in the New York Times, Time, and CBS News, among other media outlets, in part because it confirms care standards that were questioned in previous studies.

Physical therapists (PTs) play an important role in the treatment of individuals who have suffered concussions. Get the latest information on these injuries and what’s being done to reduce them at the APTA traumatic brain injury webpage (look under the "Concussion or mTBI" header). Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.